Low value of inherited thrombophilia testing among patients with stroke or transient ischemic attack: A three-year retrospective study.
Publication/Presentation Date
10-1-2023
Abstract
BACKGROUND/PURPOSE: Inherited thrombophilia testing in the acute inpatient setting is controversial and expensive, and rarely changes clinical management. We evaluated ordering patterns and results of inpatient inherited thrombophilia testing for patients who presented with an isolated acute ischemic stroke or transient ischemic attack (TIA) without concurrent venous thromboembolism.
METHODS: We retrospectively analyzed patients admitted for acute ischemic stroke or TIA between January 1
RESULTS: Among 2108 patients admitted for acute ischemic stroke or TIA (including branch and central retinal artery occlusions) during the study period, the study included 249 patients (median age 49.0 years, 50.2% female) who underwent inpatient testing for factor V Leiden, prothrombin G20210A variant, hyperhomocysteinemia, PAI-1 elevation, and deficiencies of protein C and S and antithrombin. 42.2% of patients had at least one abnormal test, and among the 1035 tests ordered, 14.3% resulted abnormal. However, 28% of abnormal tests were borderline positive antigen or activity assays that likely represented false positives. There was no significant difference in the likelihood of a positive test among patients without stroke risk factors vs those with risk factors (47.1% vs 40.9%, P = .428), nor any significant difference between those under vs over age 50 years (45.7% vs 38.3%, P = .237). No patients with an abnormal result had their clinical management changed as a result. Charges for the tests totaled $468,588 USD.
CONCLUSIONS: Inherited thrombophilia testing in the hospital immediately following isolated acute arterial ischemic stroke or TIA was associated with high rates of likely false positive results and was expensive. Positive results did not change clinical management in a single case.
Volume
32
Issue
10
First Page
107308
Last Page
107308
ISSN
1532-8511
Published In/Presented At
Majmundar, S., Thapa, S., Miller, E. S., Bell, R., Dharia, R., Tzeng, D., Alam, S., & Rhoades, R. (2023). Low value of inherited thrombophilia testing among patients with stroke or transient ischemic attack: A three-year retrospective study. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 32(10), 107308. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107308
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37633204
Department(s)
Administration and Leadership
Document Type
Article